Prospective associations between treatment for drug-use and sexually transmitted infections across racial and ethnic groups of women

Abstract

Background

Although treatment for drug-use reduces HIV/HCV risk, little is known about its relationship with other sexually transmitted infections (STIs) among women who use drugs. We examined the prospective association between receipt of treatment for drug use and incident STIs, and whether associations differ across racial and ethnic groups among women who use drugs.

Methods

We conducted a secondary analysis of a 2010 longitudinal cohort among women participants who reported drug use at baseline (n = 826). Participants completed surveys and STI testing at baseline and 6 months. The primary exposure was baseline self-reported receipt of treatment for drug use in the prior 6 months. The outcome was incident chlamydia, gonorrhea, trichomoniasis, and/or syphilis at 6 months follow up. Modified Poisson regression with robust variance estimated race and ethnicity-specific risk ratios (RRs), adjusting for baseline sociodemographic, behavioral, and health factors.

Results

STI incidence was highest among Black women (22%), followed by Hispanic/Latina women and those of other racial/ethnic groups (14%), and lowest among White women (5%). In unadjusted analyses, treatment for drug-use was associated with higher STI incidence among White women (RR = 2.83; 95% CI: 0.97, 8.29) and women of other racial/ethnic groups (RR = 3.21; 95% CI: 1.21, 8.50). In adjusted models, associations attenuated among White and Hispanic/Latina women, while among women of other racial/ethnic groups, self-help treatment remained associated with elevated STI risk (adjusted RR = 3.03; 95% CI: 1.22, 8.96). No associations were observed among Black women.

Conclusions

Among Black women who use drugs, STI risk may be shaped by structural and network-level factors rather than individual-level treatment for drug use. Integrating STI screening and prevention services into drug-related care settings may address elevated STI vulnerability. Additional research should examine mechanisms underlying racial and ethnic differences and how to reach the diverse population of women who use drugs.